addressing basic needs to improve diabetes outcomes in medicaid beneficiaries

Conditions: Diabetes Mellitus, Type 2

Summary: this pragmatic randomized trial will test the effectiveness of a basic needs navigation intervention compared to usual care among 500 adults (ages 18-75) with medicaid, type 2 diabetes, and 1 or more unmet basic needs. basic needs includes having such things as adequate food, housing, personal safety, and money for necessities. the primary study hypothesis is that participants who receive navigation to address unmet basic needs will have a greater reduction (m=0.5%) in hba1c pre-post compared with participants receiving usual care. consistent with the study's conceptual model, the effects of unmet basic needs on barriers to self-care (e.g., attention, stress, sleep), health behaviors (e.g., glucose monitoring, diet, clinical screenings) and health outcomes (e.g., emergency department utilization, hospitalization, quality of life) will be examined.

type 2 diabetes affects over 29 million us adults, with a disproportionate burden of disease borne by low-income populations. effective self-management requires attention, planning, follow-through and consistent performance of multiple health behaviors to prevent negative health outcomes. for low-income individuals, though, health improvement is often superseded by the drive to fulfill basic needs such as food, housing, personal safety, and money for necessities. having unmet basic needs can overwhelm a person's ability to maintain health behaviors. prior research has demonstrated that with more unmet basic needs, low-income individuals are less likely to even remember or act on a referral for needed health services. however, when unmet needs are resolved and/or people have a personal navigator to help, the likelihood of acting on a health referral significantly increases. traditionally, patient navigators help coordinate care, manage disease or promote screening and preventive behaviors. this study will expand the role of navigators to include identifying and resolving unmet basic needs, which is expected to facilitate behavior change and improve health outcomes. this approach will be tested in a pragmatic randomized trial conducted in partnership with louisiana healthcare connections, the largest medicaid managed care plan in louisiana. this study will test the effectiveness of a basic needs navigation intervention compared to usual care among 500 adults (ages 18-75) with medicaid, type 2 diabetes, and 1 or more unmet basic needs. the primary hypothesis is that intervention participants will have a greater reduction (m=0.5%) in hba1c pre-post compared with usual care participants. consistent with the study's conceptual model, the effects of unmet basic needs on barriers to self-care (e.g., attention, stress, sleep), health behaviors (e.g., glucose monitoring, diet, clinical screenings) and health outcomes (e.g., emergency department utilization, hospitalization, quality of life) will be examined. louisiana healthcare connections will identify eligible members for study recruitment and provide basic needs navigation for 6 months. the research team will recruit, enroll, randomize, and survey study participants by phone at baseline and 3-, 6- and 12-month follow up. hba1c data will be obtained from electronic medical records to assess change.

Eligibility criteria:
inclusion criteria: * medicaid beneficiary * member of louisiana healthcare connections * age 18-75 years old * diagnosed with type 2 diabetes * had a hba1c test in the 3-4 months prior to baseline assessment exclusion criteria: * hba1c \<7.0 in the 3-4 months prior to baseline assessment * enrolled in case management at louisiana healthcare connections in the 3 months prior to baseline assessment * are currently pregnant or have only been diagnosed with gestational diabetes at baseline * have cognitive or hearing impairments that significantly impede participation in telephone-based survey and intervention protocols. * individuals not living independently (e.g., nursing homes, rehab or correctional facilities)

Keywords: low income population diabetes mellitus, type 2 pragmatic clinical trial